| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,627 |
8,696 |
$1.67M |
| D1110 |
Prophylaxis - adult |
19,809 |
19,679 |
$1.31M |
| D1206 |
Topical application of fluoride varnish |
37,933 |
37,674 |
$1.24M |
| D0120 |
Periodic oral evaluation - established patient |
31,921 |
31,720 |
$1.20M |
| D1351 |
Sealant - per tooth |
32,339 |
8,739 |
$1.10M |
| D1120 |
Prophylaxis - child |
18,991 |
18,871 |
$803K |
| D0274 |
Bitewings - four radiographic images |
17,169 |
17,034 |
$787K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,772 |
3,893 |
$733K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,222 |
4,897 |
$604K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,437 |
3,856 |
$590K |
| D0140 |
Limited oral evaluation - problem focused |
11,505 |
10,865 |
$526K |
| D0330 |
Panoramic radiographic image |
5,184 |
5,146 |
$461K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,715 |
9,631 |
$437K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,846 |
1,351 |
$413K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,881 |
14,089 |
$355K |
| D2160 |
|
2,985 |
2,124 |
$323K |
| D0220 |
Intraoral - periapical first radiographic image |
16,367 |
15,835 |
$319K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,714 |
2,114 |
$314K |
| D1330 |
|
9,300 |
9,236 |
$312K |
| D0272 |
Bitewings - two radiographic images |
8,570 |
8,515 |
$290K |
| D2331 |
|
2,459 |
1,782 |
$265K |
| D2140 |
|
3,859 |
2,632 |
$264K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,571 |
7,964 |
$260K |
| D2332 |
|
1,798 |
1,245 |
$234K |
| D2335 |
|
1,715 |
1,202 |
$205K |
| D2721 |
|
148 |
96 |
$197K |
| D1354 |
|
4,471 |
1,502 |
$192K |
| D1310 |
|
4,361 |
4,355 |
$150K |
| D2330 |
|
1,811 |
1,276 |
$141K |
| D2161 |
|
783 |
631 |
$110K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
444 |
344 |
$77K |
| D0240 |
|
2,062 |
1,166 |
$70K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
1,675 |
1,485 |
$53K |
| D2950 |
|
193 |
150 |
$44K |
| D4341 |
|
143 |
47 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
276 |
276 |
$38K |
| D4355 |
|
558 |
553 |
$21K |
| D3310 |
|
29 |
26 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
272 |
267 |
$11K |
| D3320 |
|
15 |
15 |
$8K |
| D7220 |
|
22 |
12 |
$5K |
| D2394 |
|
39 |
37 |
$4K |
| D4910 |
|
31 |
31 |
$3K |